Feature Formula: Xiao Yao San for PMS

Xiao Yao San, or “Free and Easy Wanderer” as it is often translated in English, is a widely prescribed Chinese formula for treating menstrual disorders, depression, and digestive difficulties. Xiao Yao San has been in use for over 1000 years and includes a number of well-known Chinese herbs, including dang gui, or Angelica root. This versatile formula is extremely clinically effective in addressing a variety of menstrual difficulties, including PMS.

PMS, or pre-menstrual syndrome, is a cluster of symptoms that usually occur in the week leading up to a woman’s menstrual cycle. These symptoms can include: bloating, breast tension, irritability, depression, anxiety, constipation, loose stools, insomnia, cramps, and headaches.

For some women PMS symptoms appear right after ovulation, while other women don’t experience PMS until a day or two before the start of their period. There are also some women who don’t have PMS at all. (Yes, I swear those women exist!)

Let’s take a look at what creates PMS from a Chinese medicine perspective and how Xiao Yao San can help.

PMS in Chinese Medicine

The “ideal” menstrual period should come and go with no pain, no breast tenderness, no unholy desire to eat chocolate cake, and no “nothing fights” with your partner. But since we live in the real world, with its endless stressors, both physical and mental, many women brace themselves for PMS each month. Like clockwork, it seems we go haywire.

In reality, we do not go haywire.

Our bodies are beautifully attuned to the external world and are primed to carry life. What a miracle! But anyone who suffers through cramps, pre-menstrual depression, and loose stools every month might not exactly think a period is a miracle.

In Chinese medicine PMS symptoms have a physiological origin, meaning there are bodily explanations for why you don’t feel well. This should be a great relief to women who wonder if their pre-menstrual anxiety and agitation are all in their heads. While it’s true that PMS can create some really nasty mental states, Chinese medicine, and specifically Xiao Yao San, addresses the underlying physical imbalances that make us feel so uncomfortable.

Qi and Blood Stagnation

The natural outcome of PMS is that you eventually start to menstruate. Your period has an energy that must be released. Whether your pre-menstrual days are easy-going, like the Free and Easy Wanderer, or excruciating, is determined by how freely your qi and blood are flowing. When qi and blood are bound up, they wreck havoc.

Here’s an image I use to think of qi stagnation: imagine leaning your palms against a wall and pressing with all your body weight. The energy you’re expending leaning into this wall is magnificent, and yet, no matter how hard you try, you can’t move that wall. Instead, you become tired, agitated, and frustrated. That’s qi stagnation. It’s annoying, and somewhat painful, both to the body and the mind (not to mention the ego).

Now, imagine pounding your fists on that immovable wall. Really think about it! There you are, a vibrating ball of energy trying to get through a wall that will not yield, unless you smash into it with all your might. Smashing through that wall will hurt, but you’re totally determined to do it because you have to. That is blood stagnation, the cause of cramps, menstrual back pain, and clots.

Behind every cramp and clot are qi and blood stagnation, and the origin of this stagnation is lack of free flow. When our lives feel bound, we constrict. The same thing happens in our bodies. The same thing happens in our minds, too.

Ever notice how when someone tells you to chill out, or relax, or take it easy when you have PMS you want to scream? This is normal. PMS creates an uncomfortable tension between constriction and release that is ultimately relieved through starting your period, but before that happens, you’re still pressing and pounding on that wall. If you could relax, you would. But the truth is, you can’t, because until your body shifts from preparing for the period to actually having a period, your body is under pressure.

This is where Xiao Yao San comes in.

Xiao Yao San’s primary functions, in Chinese medicine terms, are to move qi and blood, support the Spleen (aka, your digestion), and build the blood. Let’s take a look at how Xiao Yao San supports the Spleen.  

Spleen Deficiency in Chinese Medicine

The term “spleen deficiency” is used a lot in Chinese medicine. The Spleen is the primary organ of digestion and has a similar function to the pancreas in Western medicine.

The Spleen is responsible for absorbing and distributing the nutritional aspects of our food and sending the waste materials on for elimination. When the Spleen is weak, our digestive function suffers. This can lead to gas, bloating, loose stools, constipation, weight gain, and a feeling of heaviness or lethargy. Sound familiar? Many women have irregular digestion around their periods, which is why you can’t really treat PMS if you don’t support the Spleen.

Especially as it relates to menstruation, a healthy Spleen is critical for making sufficient blood. When the Spleen is impaired, either through undernourishment (such as in crash dieting or eating disorders), or bogged down by low-quality food (think junk food, greasy meals, sugar, alcohol, and processed food) it cannot make high quality blood. For women who are menstruating, this is a problem.

High quality blood moves easily, doesn’t clot unnecessarily, and provides the proper nourishment for pregnancy. We have a good idea of the quality of our blood by seeing how it is shed in menstruation. This is a critical tool for determining our fertility, should we decide to become pregnant.

Blood Deficiency in Chinese Medicine

Chronic Spleen deficiency leads to internal blood deficiency. Blood deficiency can cause women to feel cold, experience headaches, dizziness, and brain fog, feel depressed or anxious, and have scant periods. This lack of sufficient blood can also add to menstrual cramping. Light, and especially erratic, periods are often a sign of fertility issues as well.

Moving backward from these symptoms, we can assume a woman has Spleen deficiency if she has blood deficiency. Similarly, if a woman loses a lot of blood, either through a heavy period or childbirth, it is imperative that she replenishes that blood by eating healthy food. This is one of the reasons why nutritional counseling is so important in cases of infertility. We want to be making the best blood possible for sustaining a pregnancy.

How to Use Xiao Yao San for PMS

Xiao Yao San can address PMS at any point in the menstrual cycle after the time of ovulation.

For most women ovulation occurs around 14 days after the first day of their last period. The onset of PMS symptoms can happen any time after ovulation. Sometimes it can be hard to pinpoint exactly when ovulation occurs, especially if your cycle is erratic. The average monthly cycle between periods is 28 days, but your period could fall anywhere from twenty-one to who-knows-how-long between menstrual cycle. Xiao Yao San can still help.

I advise women to start taking Xiao Yao San as soon as they have their first symptom of PMS. For many women, breast tenderness comes first. Other women notice digestive issues early. Some women become depressed, anxious, or can’t sleep. Pay attention to the symptoms you experience and see if there is a pattern. Each month you’ll become better at knowing when to start taking Xiao Yao San for PMS.

If your period runs like clockwork, and you know you’ll begin feeling lousy three days before you start menstruating, plan on starting Xiao Yao San a couple of days before those symptoms come on. Every woman is different, and this formula is safe and effective for many different types of PMS.

Xiao Yao San can also be modified to make it more cooling, more blood building, etc. Pills are an easy way to take this formula, but some women need a more specialized formula, which requires a customization of raw herbs or herbal powders. Ask your acupuncturist or Chinese herbalist what the best form of Xiao Yao San is for your particular type of PMS.

This versatile formula is one of my favorites. I’ve seen many women go from having PMS every month to barely noticing when their period is on the horizon. I love how gentle it is at working with a very complex (and irritating!) set of symptoms. If you have PMS, definitely talk with your practitioner about trying Xiao Yao San.

For additional information on using this formula in a clinical setting, see Memorial Sloan Kettering Cancer Center’s About Herbs listing for Xiao Yao San